In understanding psychopharmacology, it is helpful to place it within the proper historical context. Below, we’ll take a look at psychopharmacology’s history and how it has unfolded into the biologically focused specialty of today.
In the late 1800s, psychiatry was clearly rooted in the medical model and highly influenced by the burgeoning field of neurology. Psychiatrists believed, almost exclusively, that mental illness could be attributed to some sort of biologic disturbance. This conclusion was the case even though very little was known about the brain and biology of mental illness. Regardless, the earliest attempts to approach the understanding of mental illness in this era involved two main areas of investigation.
On one front was the development of the first systematic nosologic system by Emil Kraepelin. This pioneering work laid the foundation for all later diagnostic schema (such as the Diagnostic and Statistical Manual of Mental Disorders, or DSM). And many of Kraepelin’s original notions about the classification of major mental illness have stood the test of time.
He was a brilliant investigator and the one most responsible for ushering in descriptive clinical psychiatry. However, his endeavors must have been accompanied by a good deal of frustration and impotence, since, despite the development of a systematic approach to diagnosis, Kraepelin and other psychiatrists of his time had few, if any, methods of treatment.
At the same time, the hunt was on for evidence of brain pathology, which was presumed to underlie mental illness. Research was conducted in neuroanatomy labs across the world but yielded few concrete results. For example, the famous French neurologist Jean-Martin Charcot believed that hysterical conversation symptoms were undoubtedly because of some type of central nervous system lesion.
He explained the fact that no demonstrable pathology could be isolated on autopsy by saying it simply suggested that somehow the lesion mysteriously disappeared at the time of death. We must bear in mind, however, that in all likelihood, these researchers and clinicians were desperate to find causes and cures and went at it by the means best known to them (biology) and using the scant technology available at the time.
Biological psychiatry got a shot in the arm in the late 1800s as two discoveries were made. At the time, probably one half of those housed in asylums suffered from a type of psychotic-organic brain syndrome that ultimately was found to be caused by the Treponema pallidum bacteria (a central nervous system infection seen in the late stages of syphilis).
It was also eventually discovered that some organic mental syndromes were because of pellagra (a disease associated with niacin and protein deficiency). These were important discoveries, and they fueled enthusiasm in biological psychiatry. It was just a matter of time, it was felt, before other biologic causes would be isolated and medical treatments developed.
However, such discoveries did not occur until the middle of the 20th century. For practical purposes, biological psychiatry came to a halt as it entered the 1900s.
Divergent Approaches Emerge
The disappointments stemming from medical research on mental illness and the failure to develop any effective treatment probably increased the receptivity of psychiatry to divergent approaches. At this same time, Sigmund Freud was assembling the basic notions of psychoanalysis. Freud’s initial theory was strongly influenced by his own medical and neurological training (for example, his “Project for a Scientific Psychology,” 1895), and many of his prevailing ideas continued to have their roots in biology, including drive theory, instincts, and psychosexual development. However, his newly emerging theory and techniques of treatment sparked interest in the use of novel, nonmedical approaches to treatment.
By the 1920s, psychological (rather than biological) explanations for the development and treatment of psychopathology had found their place in clinical psychiatry, and by the 1940s, psychodynamic thinking had permeated American psychiatry and become the dominant theoretical model.
Yet these newly developed approaches proved to be inadequate in the treatment of the more serious forms of mental illness, such as schizophrenia and manic-depressive psychosis. In one of his last manuscripts, Freud himself admitted his disappointment in psychoanalytic methods for treating schizophrenia. He hypothesized that eventually it would be discovered that these grave mental disorders were because of some form of biologic abnormality, and that perhaps drugs would eventually be found to treat these illnesses.
*This article is based on Dr. Moore’s latest book “Handbook of Clinical Psychopharmacology for Therapists” published by New Harbinger Press and coauthored by John Preston, John O’Neal, and Mary Talaga.
Preston, J., O’Neal, J., Talaga, M., & Moore, B. A. (in press). Handbook of Clinical Psychopharmacology for Therapists-Ninth Edition. Oakland, CA: New Harbinger Press.